Physiotherapy for Trail Runners: Guide to Ankle Rehabilitation and Injury Prevention  

Ankle sprains are a common injury among trail runners, and they can be a frustrating setback for those who love to hit the trails. While self-care is important for immediate treatment, working with a professional physiotherapist can be invaluable in guiding a safe and effective return to running, reducing the risk of re-injury, and addressing any ongoing issues related to the “difficult ankle”. In this article, we will explore how physiotherapy can help trail runners recover from ankle sprains and prevent future injuries through a science-based approach. 

Incidence and risk factors 

Ankle pain is a common complaint among runners, with research showing that it affects approximately 15% to 20% of runners each year. The incidence and risk factors for ankle pain in runners can vary depending on the population being studied and the factors being considered. Here are some of the key findings from research on the topic: 

  1. Incidence: One study published in the British Journal of Sports Medicine found that 20% of the runners surveyed reported experiencing ankle pain in the previous year. Another study published in the Journal of Athletic Training found that 15% of the cross-country runners surveyed experienced ankle pain during the previous season. 
  1. Risk factors: Several risk factors have been identified that can increase the likelihood of developing ankle pain in runners. These include: 

Previous ankle injury:  

Runners with a history of ankle injuries are at a higher risk of developing ankle pain due to residual weakness, instability, and altered biomechanics. 

Training errors:  

Overuse injuries, including ankle pain, can occur when runners increase their training intensity or volume too quickly, without allowing for adequate rest and recovery time. 

Foot mechanics:  

Runners with abnormal foot mechanics, such as overpronation or supination, may be at a higher risk of developing ankle pain due to increased stress on the ankle joint and surrounding structures. 


Inappropriate or worn-out running shoes can contribute to ankle pain by altering foot mechanics and increasing stress on the ankle. 

Running surface:  

Running on hard or uneven surfaces can increase the risk of ankle pain by increasing stress on the ankle joint and surrounding structures. 


To prevent ankle pain, runners should take steps to address the risk factors mentioned above. This may include gradually increasing training intensity and volume, wearing appropriate running shoes, and running on even and forgiving surfaces. Runners with abnormal foot mechanics may benefit from orthotics or other supportive devices that can help correct foot mechanics and reduce stress on the ankle joint. 

Intelligent Rehab for Efficient Recovery 

As we age, our bodies lose some of their natural regenerative abilities, and injuries that might have healed quickly during childhood can require more attention and care. Ankle injuries are no exception. That is why it is important to take a smart and strategic approach to rehabilitation, guided by a skilled physiotherapist. By developing a personalized rehabilitation plan that incorporates “relative rest” and progressive rehabilitation from the beginning, trail runners can ensure an efficient recovery and minimize the risk of complications or chronic issues related to the injury. 

Tackling the “Difficult Ankle” and Rehabilitation Importance 

A “difficult ankle” can result from inadequate or incomplete rehabilitation, leading to ongoing issues like chronic pain, swelling, reduced range of motion, recurrent sprains, and altered gait. To prevent these complications, trail runners should work with a skilled physiotherapist to develop a personalized rehabilitation plan that focuses on relative rest and progressive rehabilitation. 

A physiotherapist can play a vital role in helping trail runners recover from ankle sprains and get back to running safely.  

Here are some of the ways that physiotherapists can help: 

  1. Pain Management:  

A skilled physiotherapist can provide techniques and modalities to manage pain and reduce inflammation, such as ice, compression, and elevation. They can also help trail runners rebuild movement early on, promoting healing and reducing discomfort. 

  1. Relative Rest and Mobility:  

Instead of complete rest, engaging in modified activities can maintain fitness and mobility without harming the injured area. This approach can reduce pain and swelling while improving range of motion, strength, and function. 

  1. Strength and Stability: 

Strengthening exercises can rebuild ankle muscles and improve stability, introduced at the appropriate recovery stage. 

  1. Balance and Proprioception Training:  

Improving balance and proprioception can reduce the risk of re-injury and promote a stable, functional ankle for uneven trail running terrain. 

  1. Gradual Return to Sports and Activities:  

A tailored plan for a gradual return to trail running and other sports can ensure preparedness without risking re-injury. 

Preventing Future Sprained Ankles for Trail Runners 

In addition to helping trail runners recover from ankle sprains, physiotherapists can also play a vital role in preventing future injuries. By providing valuable advice and exercises, physiotherapists can help trail runners reduce the risk of re-injury and stay healthy on the trails.  

Here are some of the strategies that physiotherapists may recommend: 

  1. Balance and Proprioception Training:  

Enhancing ankle stability and responsiveness to uneven surfaces and sudden direction changes in trail running. 

  1. Lower Leg Strengthening:  

Providing additional ankle support, reducing the risk of sprains. 

  1. Sport-Specific Drills:  

Improving technique and movement patterns, minimizing injury risk. 

  1. Footwear and Equipment Recommendations:  

Appropriate footwear and proper equipment are essential for trail running injury prevention. 


By working with a physiotherapist, trail runners can benefit from expert guidance and personalized care during sprained ankle recovery. Through intelligent rehab, physiotherapists can help runners overcome the limitations of natural healing and ensure a confident return to an active lifestyle and favourite trails. 

Want to chat with us directly?